Modulation of the OCD neural network by conventional treatment

PROJECT SUMMARY/ABSTRACT
McLean Hospital Project 4
The main goal of the proposed project, entitled “Modulation of the OCD neural network by conventional
treatment,” is to study how conventional interventions for severe OCD – intensive exposure and response
prevention (ERP) therapy and standard of care medication management – affect the putative OCDnet to further
our understanding of how commonly available, efficacious treatments for OCD impact neural circuits involved in
avoidance and aversive uncertainty. To achieve this goal, P4 will identify abnormalities in the vlPFC, rACC,
insula, dACC, OFC and rostral striatum that track with performance on the PAAT and clinical symptom reports
in individuals with OCD as they receive intensive treatment and undergo changes in illness burden over time.
The project will follow 95 individuals with OCD using intensive longitudinal assessment of brain and behavior
over the typical ~8wk treatment course. P4 will build on our group’s operational experience performing serial
MRI (functional and structural) and detailed serial clinical assessments in OCD, and our toolkit for intensive
longitudinal assessment, currently deployed in other NIMH-funded data collection efforts and developed with
members of Core C, to identify changes in the OCDnet, persistent avoidance (as measured on PAAT and with
exploratory device-based measures), and clinical changes in OCD. Three sets of comprehensive study visits
(before, during, and after treatment) with MRI and clinical assessments will provide illness trajectory information
for probing relationships between changing constructs at a coarse timescale, complemented by low-burden,
digital phenotyping to capture variation at intermediate and finer time scales. Elucidating the ways in which the
putative OCDnet changes in relation to changes in clinical and therapeutic parameters will provide targets for
new interventions for OCD and help understand how and in which individuals currently available treatments
achieve their optimal therapeutic benefit.

Grant Number: 5P50MH106435-09
NIH Institute/Center: NIH
Principal Investigator: JUSTIN BAKER